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<title>ReferralProcessingSelectionForm2</title>
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<h3 align="center">Referral Processing Selection </h3>
<h1 align="center">
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      <table cellspacing="0" cellpadding="3" width="100%" align="center" border="0">
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            <p align="right"><input maxlength="30" value="Search Keyword" 
            name=searchKeyword><input type="button" value="Go" name="searchKeywordGoButton"></p></td>
          <td>
            <p align="right"><input type="checkbox" value="All" 
            name=applicationFilterCheckGroup> All</p></td>
          <td width="95">
            <p align="right"><input type="checkbox" value="Pending" 
            name=applicationFilterCheckGroup> Pending</p></td>
          <td width="200">
            <p align="right"><input type="checkbox" value="Pending + Info Requested" 
            name=applicationFilterCheckGroup> Pending + Info 
        Requested</p></td></tr></tbody></table></td></tr>
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      align=left bgColor=#d6d6d6 border=2>
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          <td width="40">
            <p align="center"><strong>Application Date</strong></p></td>
          <td width="20">
            <p align="center"><strong>Qualifed</strong></p></td>
          <td>
            <p align="center"><strong>Primary Member</strong></p></td>
          <td>
            <p align="center"><strong>&nbsp;Patient Name</strong></p></td>
          <td width="20">
            <p align="center"><strong>Status</strong></p></td>
          <td width="20">
            <p align="center"><strong>Type</strong></p></td>
          <td width="60">
            <p align="center"><strong>Specialty&nbsp;&nbsp;&nbsp; </strong></p></td>
          <td>
            <p align="center"><strong>Condition Description</strong></p></td></tr>
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          <td width="40">&nbsp;</td>
          <td width="20">&nbsp;</td>
          <td>&nbsp;</td>
          <td>&nbsp;</td>
          <td width="20">&nbsp;</td>
          <td width="20">&nbsp;</td>
          <td width="60">&nbsp;</td>
          <td>&nbsp;</td></tr>
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          <td>&nbsp;</td>
          <td>&nbsp;</td>
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          <td width="60">&nbsp;</td>
          <td>&nbsp;</td></tr>
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          <td>&nbsp;</td>
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          <td></td>
          <td></td>
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          <td></td></tr>
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          <td></td></tr></tbody></table></ TD></td>
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      <table cellspacing="0" cellpadding="3" width="100%" align="center" border="0">
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            <p class="MsoNormal" style="MARGIN: 0in 0in 0pt"><b 
            style="mso-bidi-font-weight: normal"><span 
            style="mso-spacerun: yes">&nbsp;</span>(Highlight Row and Click 
            Select Button)<o:p></o:p></b></p></td>
          <td>
            <p align="right"><input style="LEFT: 999px; WIDTH: 140px; TOP: 511px; HEIGHT: 24px" type="button" size="36" value="SELECT" name="applicationSelectButton"></p></td></tr></tbody></table>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
    </td></tr>
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    <td><input style="WIDTH: 133px; HEIGHT: 25px" type="button" size="48" value="BACK" name="backButton">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input style="WIDTH: 117px; HEIGHT: 27px" type="button" size="58" value="EXIT" name="exitButton"></td></tr></tbody></table></ 
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